Social Medicine in the 21st Century

Book excerpt: PLoS Medicine's October 2006 issue contained a special collection of eleven magazine articles and five research papers devoted entirely too social medicine. The collection featured many of the leaders in the field, including Paul Farmer, Arthur Kleinman, David Satcher, Nancy Scheper-Hughes, Dorothy Porter, and Leon Eisenberg. The Kaiser Family Foundation has conducted interviews with two of the authors of papers in this collection, David Satcher and Paul Farmer. In its launch issue in October 2004, PLoS Medicine signaled a strong interest in creating a journal that went beyond a biological view of health to incorporate socioeconomic, ethical, and cultural dimensions. For example, that first issue contained a policy paper on how the health community should respond to violent political conflict a debate on whether health workers should screen all women for domestic violence, and a study on the global distribution of risk factors for disease. Two years on, our October 2006 issue takes our interest even further. It contains a special collection of ten magazine articles and fi ve research papers devoted entirely to social medicine. We are delighted that the collection features many of the leaders in the fi eld, including the renowned medical anthropologists Paul Farmer and Arthur Kleinman, the former United States Surgeon General David Satcher, and the Harvard professor of social medicine and psychiatry Leon Eisenberg. Most of our readers have welcomed our inclusive view of what a medical journal should highlight. Some, however, have been critical, suggesting that we should publish "less soft stuff" and more "hard science." These critics might argue that in this era of stem cell research and the human genome project, of molecular medicine and DNA microarray technology, the notion of social medicine seems irrelevant and outmoded. But the ultimate role of a medical journal is surely to contribute to health improvement, and that means looking not just at molecules but at the social structures that contribute to illness. The stark fact is that most disease on the planet is attributable to the social conditions in which people live and work. The socially disadvantaged have less access to health services, and get sicker and die earlier than the privileged. Despite impressive technological advances in medicine, global health inequalities are worsening.